Table 2.
Study Eligibility by Cohort
| STUDY COHORT | Suboptimal Care Criteria | Rational for Suboptimal Care Threshold | Adherence Thresholds |
|---|---|---|---|
| Hypertension | Index date and the prior encounter date with systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥ 90 mmHg | Consistent with the ACC/AHA Blood Pressure Guideline Consistent with HEDIS measure for controlling High Blood Pressure |
PDC <80% with moderate or high data confidence for all medications in at least one class of antihypertensive medications. Classes of hypertensive medications included (a) diuretics (thiazides or loop), (b) angiotensin converting enzyme inhibitors or angiotensin receptor blockers, (c) calcium channel blockers and (d) beta blockers. |
| DM | Met criteria for suboptimal glycemic control defined as most recent A1C ≥8% in the 12 months prior to index | Consistent with American Diabetes Association guideline Consistent with A1C component of HEDIS measure for Comprehensive Diabetes Care |
PDC <80% with moderate or high data confidence for all medications in at least one class of active non-insulin glycemic medications. Classes of non-insulin glycemic medications included (a) biguanides (e.g., metformin), (b) Insulin secretagogues (e.g. sulfonylureas or meglitinides), (c) glucagon-like peptide 1 receptor agonists, (d) sodium-glucose co-transporter 2 inhibitors, (e) dipeptidyl peptidase-4 inhibitors and (f) thiazolidinediones. |
| Lipid | Met one of the high-risk categories for recommending statin usea
Patients with most recent LDL < 100 mg/dL in the last two years were excluded from the lipid cohort because they could be at a recommended LDL goal despite potential statin nonadherence. |
Categories for statin usea and LDL goals were based on the ACC/AHA lipid guideline.73
HEDIS measure for statin therapy for patients with cardiovascular disease or diabetes |
PDC <80% with moderate or high confidence (for all currently prescribed statins). |
a
ACC/AHA Categories for statin use included:
a. Aged >21 years with atherosclerotic cardiovascular disease (ASCVD) identified by an ASCVD diagnosis on the problem list or two or more International Classification of Diseases 10th revision (ICD10)74 codes for ASCVD conditions in the last 2 years.
b. Aged >21 years and LDL >190 mg/dL.
c. Aged 40 to 75 years AND diagnosis of DM. DM was determined from DM on the problem list or two or more encounter IDC10 codes for DM in the last 2 years.
d. Aged 40 to 75 years with 10-year ASCVD Risk Score ≥7.5% based on the ACC/AHA 10-year Pooled Cohort risk equations.75